LAUSR

Dear Editor, After reading the article “Clinical trial for uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): adverse effects approach”1 in your esteemed journal, I had several questions skin pigmentation (21.7%) and xerosis (16.9%) were the most frequent complaints among 753 patients.1 Comments Pigmentation and xerosis are due to clofazimine, and not to either dapsone or rifampicin. In a patient proven to be paucibacillary by lesion counting and BI, and treated with the six-month World Health Organization (WHO) paucibacillary regime of dapsone and rifampicin, the question of clofazimine-induced pigmentation or xerosis does not arise, and hence when such a patient is treated with MDT-U, the patient is definitely exposed to additional risk of clofazimine-induced pigmentation and possibly a risk of non-compliance. The said study1 does not address the issue. Since 1982, millions of patients have been treated and cured with MDT, and reports of adverse effects (AE) have been quite low when compared to the benefits for patients and leprosy control programs.2 The study in question states that 24 patients (3.2%) stopped dapsone because of AE and received an alternative treatment; 16 (66.7%) had anemia, three patients of this group had leukopenia, and two developed mild increase in their aminotransferase levels. Three patients (12.5%) developed erythroderma secondary to dapsone, and all these patients had mild anemia. Methemoglobinemia was diagnosed in one patient. Unanswered questions on the safety of MDT-U* CorrespondenCe